一氧化氮及内皮素1与急性ST段抬高型心肌梗死直接经皮冠状动脉介入患者无复流相关性研究  

Relation among nitric oxide,endothelin-1 and no-reflow after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

作　　者：蒋志丽[1] 王成钢[1] 李艳芳[1] 阙斌[1] 聂绍平[1] Jiang Zhili;Wang Chenggang;Li Yanfang;Que Bin;Nie Shaoping(Department of Emergency,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院急诊科,100029

出　　处：《中国医药》2020年第2期165-168,共4页China Medicine

基　　金：北京市卫生和计划生育委员会首都卫生发展科研专项(2018-1-2061);北京市医院管理局重点医学专业发展计划(ZYLX201710)。

摘　　要：目的探讨急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入(PCI)术后血清一氧化氮、内皮素1与PCI术后心肌组织再灌注水平的关系。方法选取首都医科大学附属北京安贞医院2017年1月至2018年7月首次因STEMI行急诊直接PCI治疗的患者共292例,按PCI术后心肌梗死溶栓试验(TIMI)血流分级情况分为3组,A组(TIMI 3级,185例)、B组(TIMI 2级,73例)、C组(TIMI 0~1级,无复流,34例),比较3组患者血清一氧化氮及内皮素1浓度差异。结果A组及B组患者血清一氧化氮浓度均低于C组[(58±12)、(50±11)μmol/L比(44±13)μmol/L],且B组明显低于A组(均P<0.05);A组及B组患者血清内皮素1浓度均高于C组[(8.0±2.2)、(6.1±1.2)ng/L比(5.1±1.2)ng/L,均P<0.05],A组与B组内皮素1差异无统计学意义(P>0.05)。Logistic回归分析发现,内皮素1是STEMI患者PCI术后发生无复流的危险因素(比值比=2.013,95%置信区间:1.563~3.015,P=0.032),一氧化氮则对无复流具有保护性作用(比值比=0.502,95%置信区间:0.261~2.011,P=0.044)。结论STEMI患者血清一氧化氮及内皮素1表达水平同直接PCI术后心肌灌注水平显著相关,检测血清一氧化氮及内皮素1对评估患者病情具有重要意义。Objective To investigate the relation among nitric oxide(NO),endothelin-1(ET-1)and myocardial reperfusion after primary percutaneous coronary intervention(PCI)in acute ST-segment elevation myocardial infarction(STEMI)patients.Methods A total of 292 patients with initial diagnosis of STEMI undergoing PCI in Beijing Anzhen Hospital,Capital Medical University from January 2017 to July 2018 were enrolled.The patients were divided into 3 groups by thrombolysis in myocardial infarction(TIMI):group A(TIMI grade 3,185 cases),group B(TIMI grade 2,73 cases),group C(TIMI grade 0-1,no-reflow,34 cases).Serum levels of NO and ET-1 were analyzed.Results Serum NO concentration in group A and B was significantly lower than that in group C[(58±12),(50±11)μmol/L vs(44±13)μmol/L,P<0.05],and it was significantly lower in group B than that in group A(all P<0.05).Serum ET-1 concentration in group A and B was significantly higher than that in group C[(8.0±2.2),(6.1±1.2)ng/L vs(5.1±1.2)ng/L,P<0.05];no statistical difference was noticed between group A and group B(P>0.05).Logistic regression analysis showed that ET-1 was a risk factor of no-reflow(odds ratio=2.013,95%confidence interval:1.563-3.015,P=0.032);NO was a protective factor of no-reflow after PCI in STEMI patients(odds ratio=0.502,95%confidence interval:0.261-2.011,P=0.044).Conclusion Serum NO and ET-1 in STEMI patients are associated with myocardial perfusion after primary PCI.

关 键 词：急性ST段抬高型心肌梗死 直接经皮冠状动脉介入 一氧化氮 内皮素1 

分 类 号：R541[医药卫生—心血管疾病]